How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage?
How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage?
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DOI：
10.1378/chest.119.2.478
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发表时间：
2001-02-01
期刊：
影响因子：
9.6
通讯作者：
Borzak, S
中科院分区：
文献类型：
--
作者：
Ananthasubramaniam, K;Beattie, JN;Borzak, S
研究目的：为了确定血栓栓塞的风险后，扣留或逆转华法林治疗的影响，以下major hemorrhage.Design：回顾性病历review。设置：三级护理hospital.Patients：28例接受华法林的人工心脏瓣膜患者住院治疗的大出血，从1990年至1997年。平均+/- SD年龄为61 +/- 11岁（15名男性和13名女性）。20例患者植入了St. Jude瓣膜，4例患者植入了Carpentier-Edwards生物瓣膜，2例患者植入了Starr Edwards瓣膜，2例患者植入了Bjork-Shiley瓣膜。12例患者的瓣膜位于二尖瓣位置，12例患者的瓣膜位于主动脉位置，4例患者的瓣膜位于二尖瓣和主动脉位置。从瓣膜手术到出血的平均间隔时间为7年。25例胃肠道或腹膜后出血，2例颅内出血，1例硬膜下hematoma.Interventions：维生素K给予5例患者和新鲜冷冻血浆给予7例患者逆转抗凝。抗凝停药的平均持续时间为15 +/- 4 day.Measurements和结果：所有患者均未发生血栓栓塞并发症。有4人在医院死亡。24名住院幸存者中有22名在出院时重新开始华法林治疗。在6个月的随访中，10 19例仍在华法林治疗复发GI bleeding.Conclusions：血栓栓塞的风险是低的人工心脏瓣膜患者住院时，他们的华法林治疗逆转或扣留大出血。恢复抗凝治疗后6个月内复发性出血很常见，需要考虑出血源的积极治疗和继续抗凝治疗的风险-获益比。
Study objectives: To identify the risk of thromboembolism after withholding or reversing the effect of warfarin therapy following a major hemorrhage.Design: Retrospective medical record review.Setting: Tertiary-care hospital.Patients: Twenty-eight patients with prosthetic heart valves receiving warfarin were hospitalized for major hemorrhage from 1990 to 1997. The mean +/- SD age was 61 +/- 11 years (15 men and 13 women). Twenty patients had St. Jude valves, 4 patients had Carpentier-Edwards bioprosthetic valves, 2 patients had Starr Edwards valves, and 2 patients had Bjork-Shiley valves. Valves were in the mitral position in 12 patients, the aortic position in 12 patients, and both mitral and aortic positions in 4 patients. The average interval from valve surgery to index bleeding wa 7 years. Twenty-five patients had GI or retroperitoneal hemorrhage, 2 patients had an intracranial hemorrhage, and 1 patient had a subdural hematoma.Interventions: Vitamin K was administered to five patients and fresh frozen plasma was given to seven patients to reverse anticoagulation. The mean duration of anticoagulation withholding was 15 +/- 4 days.Measurements and results: None of the patients had thromboembolic complications. There were four in-hospital deaths. Twenty-two of the 24 hospital survivors resumed warfarin therapy at hospital discharge. At 6-month follow-up, 10 of 19 patients remaining on warfarin therapy had recurrent GI bleeding.Conclusions: Thromboembolic risk is low in prosthetic heart valve patients hospitalized with major hemorrhage when their warfarin therapy is reversed or withheld. Recurrent bleeding within 6 months of the resumption of anticoagulation is common, and aggressive treatment of the bleeding source and the risk-benefit ratio of continued anticoagulation need to be considered.